Managing self-harm - practical responses

When young people harm themselves their families are faced with practical issues about hiding sharp objects and pills, dealing with wounds and being alert to further episodes of harm. These were important concerns for the parents and carers we spoke to.

Many were advised by the Child and Adolescent Mental Health Service or their General Practitioner to hide anything which could be used for self-harm. Although they tried to do this, several acknowledged that it was impossible to prevent the young person finding a way to self-harm. Sarah Z, Jim and Jo-Ann took razors and scissors away but their children found other methods of cutting.

Annette, 54, is single with a 28 year old son. She used to work as an administrator, and is now a part-time student. Ethnic background: White British.

I had to hide, [laughs] lock away, [laughs] any chemicals and things like that because he’d drink anything. Anything that was in the cupboard, put them away or better still, don’t have them. Any knives, don’t have any knives in your house. Just don’t have them because they can’t help themselves, you know. They’re beyond helping themselves. They need someone outside to help in and so I was very aware of that, that I needed to do that and I think that’s an important thing is to be aware, to be attentive at all times

Text changed in accordance with Annette’s wishes.

view profile

Profile Info

Age at interview:

61

Sex:

Male

Background:

Charles, 61, is a retired company director, married with three children aged 17, 14 and 12. Ethnic background: White British.

Is there anything else that you think is important that you’d like to talk about?

I probably should know more about the practicalities, just the practicalities. I mean when one’s child goes thumping upstairs in a fury and one worries that he’s going to harm himself, what can one do? And it’s ludicrous to say, oh well, in fact, we do do it, we look for belts and ties and stuff and try and hide them but they’re always there - probably wouldn’t take him five minutes to find where they’re hidden. And there are always going to be sharp objects, scissors, geometry sets, which he’s used, or any number of implements. I mean well, glasses, bottles, tins, goodness knows what. One can’t, other than locking him up in a padded cell, are there practical ways of minimising risk? I don’t know.

view profile

Profile Info

Age at interview:

49

Sex:

Female

Background:

Jane is married with two daughters aged 15 and 17. She works from home helping manage her husband’s business. Ethnic background: White British.

Constantly, the, the CAMHS [Child and Adolescent Mental Health Service] thing, they were saying, “You must remove all alcohol from the house, and every sharp object has to be removed from the house. You must take anything that is a possible thing that she could use, to hurt herself or to harm herself, or potentially could commit suicide with.” Has anybody ever walked round the house and tried to do that? It is, it’s just not possible and, apart from anything else, what you’re doing is saying to your child, “I don’t trust you.”

“I don’t think you are capable of dealing with the situation.” And, so actually, we didn’t and, you know, she has carried on self-harming. It’s a lot less now than it was, considerably less now, and, and perhaps say now, I don’t think that she is doing it, or if so, is very occasional. You you’ve got to take away the ‘need’ to self-harm. You can’t stop the self-harming itself, so don’t try to, and one of the things that this consultant said, he said, “Just be practical about it.” He said, “Make sure she’s got plasters, and bandages, and antiseptic, and just say to her, you know, ‘just deal with it sensibly, you know. If you do hurt yourself, just make sure that you clean it up and, you know, you do this that and the other,’ and suddenly it becomes normal. It becomes like falling over and grazing your knee, and it becomes something which is open, and not being hidden.” And because that’s the other thing, it’s the shame.

Yeah.

Of it, which is more damaging, than any of it. So, I think, you know, that sort of thing helped, but why won’t CAMHS say that to us? Why weren’t they saying that and not “remove all alcohol and sharp object from the house”? Because, basically, what they were saying to us, if you have a single thing in your house that she could hurt herself with, you are responsible for what she’s doing, and, you know, it, it’s really hurtful. So actually, we didn’t do any of the clearing the house stuff. We didn’t leave her on her own in the house, at all. We did keep an eye, but, you know, it’s so damaging when a young person feels they’re being watched all the time.

Sometimes hiding sharp objects and pills caused problems – Sandra forgot where she’d put things, Anna, Jackie and Jane S had difficulty finding sharp knives when they were needed in the kitchen, and Jane’s husband had to switch to an electric razor so there were no razor blades in the house.

Although parents realised it was impossible to hide all means of self-harm, trying to do this felt like something positive they could do. Liz told us: ‘We’d been advised to move anything that was potentially dangerous from her room but, actually, they can use anything. We did it because I needed to feel that I was doing something, but it’s a bit of a nonsense really, because if you want to cut yourself, you can cut yourself.’ Jane S said that her daughter’s younger sister ‘made it her business going around hiding everything, which was her way of coping.’ Nicky would regularly go through her daughter’s room and throw away all her blades. ‘I know it’s futile’, she admitted, ‘because I know she’d go out and buy more, but I suppose my rationale was at least there is a small window between her realising she hasn’t got anything to cut with and her being able to go out and acquire something else. …That was part of my coping strategy, I suppose, in having some modicum of control over it all.’

Other parents told us of strategies they used to prevent self-harm. Tam let her daughter use her eye-liner sharpener, but only when she could see her doing this. When Sandra’s daughter seemed to be recovering Sandra gradually put out some of the things she’d hidden, and when her daughter didn’t use them for self-harm she brought out the rest.

Another practical aspect of self-harm which worried many parents was dealing with the injuries which resulted from it. Wounds varied in severity – while some needed relatively little care and could be treated at home, others were so bad that the young person had to be rushed to hospital. Bernadette had to dress her son’s serious burns herself, with help from the practice nurse. Joanne was given packs of bandages by the nurses at her GP’s surgery. ‘Now I’m quite immune to it,’ she told us. ‘I can see her arm slashed and I will just stick it back together myself. …I’m quite a professional’. Jo, a nurse, found caring for her daughter’s wounds a positive experience: ‘I felt like I was being a mother, a rescuer, a professional, a carer, something nice in her life’.

Jane is 54, married with three children. She is director of a charity. Ethnic background: White British.

So looking for, you know, signs of wound problems and having a relationship where, you know, my daughter, for instance, with the, a horrible infection that she had at the time didn’t feel she could come and talk to me about it. She told a counsellor, who she was seeing for the eating disorder, who actually booked a doctor’s appointment for her and my daughter went on her own and I felt really terrible about that. I felt that if I’d been perhaps more understanding at that time, she would have been able to say to me, you know, “Mum, this doesn’t look right. This wound hurts and it’s angry, you know, and starting to fill with pus.” And she felt, obviously, that she couldn’t tell me that. She couldn’t show me and it wasn’t just because I’d have been upset. It was because, at that time, she didn’t think that I would understand and that I might be angry with her and I think that was a key moment for me, realising that if I wasn’t able to try and put aside some of my emotions and really listen to her and help her in a structured way, I know that sounds very clinical, I don’t mean it like that but you know what I mean, then she would just ignore, you know, she would have to leave me out and she would have to go it alone and I couldn’t bear that.

view profile

Profile Info

Age at interview:

47

Sex:

Female

Background:

Ann, 47, is a nurse, married with three children. Ethnic background: White British.

I just wondered if you could say something about managing the wounds.

Well, cuts come in all shapes and sizes and in all parts of the body and, actually, the one that I first saw on my daughter’s arm, I actually didn’t see the multitude that were actually on her tummy and, as a result, she’s got some very unsightly, thick, keloid scars on all part of her body, the tummy, the arms, the thighs, her neck now. Scratches, which is what a lot of them do, and, I think they call it cobwebbing or webbing or something that that’s because, ultimately, that’s what they end up looking like is a very fine cobweb. They tend to heal quite quickly and don’t tend to be too deep and I feel confident just popping a plaster on those. It’s the deeper ones that you have to guard against and I think, when you look at a cut, you know, if it’s constantly bleeding obviously, you need to get somebody to hospital.

If it’s spurting out then you need an ambulance because they’ve probably hit an artery or something.

And, thankfully, we’ve never had that.

As for closing up wounds, because I’m a nurse, I’ve perhaps got a little bit more confidence in doing it but there have been many occasions that I can see layers that have gone through and I didn’t feel comfortable closing that up because I knew it would scar if it wasn’t closed properly and I have no hesitation going to A and E. And yes, they’ll ask why they did it and are they under services and, you know, it can be a pest if you’re there for hours and hours and hours just for a cut but it’s why they’ve done it isn’t it. I think quite often they won’t say why they’ve done it. So for now, we just, well, I use plasters or I’ve got my own little steri-strips, the butterflies. I’m not fond of going up to the hospital at all but it can mean the difference between leaving a scar and no scar.

Several parents stressed the importance of self-care. ‘If you’re going to damage yourself’, Jackie advised, ‘make sure that you’re doing it in as safe a way as possible.’ Jackie and Tracey warned their children about the risks of wounds becoming infected. Alexis ‘went into practical mode. Maybe practical mode was easier to deal with than emotional mode, it’s “okay, we have to look after these cuts”. So you buy your Savlon and you buy your cotton wool and you look after the cuts because that’s the easy bit.’ The Child and Adolescent Mental Health Service team showed Ruth’s daughter how to care for her wounds. Nicky and Jackie pointed out that some people might be shocked that clinicians and websites were giving information about how to harm yourself, but they agreed that safer cutting was important.

When a young person has harmed themselves their family is usually very worried that they may do it again. Parents we spoke to were no exception: Susan Y said she was checking her daughter every day, making her keep the bathroom door open, and looking to see if there were any more scars. Pat was ‘in a state of red alert constantly’. Fiona feared for her son: ‘I’m sort of watching him like a hawk with part of me but I don’t want him to feel that I’m watching his every move.’ Other parents also tried to hide this monitoring from their children.

Annette, 54, is single with a 28 year old son. She used to work as an administrator, and is now a part-time student. Ethnic background: White British.

They’re beyond helping themselves. They need someone outside to help in and so I was very aware of that, that I needed to do that and I think that’s an important thing is to be aware, to be attentive at all times.

Definitely attentive. It is tricky because it does take a lot out of you, as a person, yeah, it does take a lot out of you but those subtle signs being consciously aware all the time, not aggravating the person or him. And also be in the shadow really, you know. Being their shadow, following what they do, doing what they like and encouraging them to do good things as well as not just the dark things.

Now it’s funny, you know, throughout all that time these things, the cutting particularly, really sharpened at my awareness. In fact, I was on red alert, you know. The stress was high. I was very anxious about everything. I was on twenty four red alert [laughs] watching and making sure. I didn’t sleep properly.

view profile

Profile Info

Age at interview:

49

Sex:

Female

Background:

Sandra, 49, is a social worker, married with two daughters. Ethnic background: Black British.

We had to be vigilant. We had to be on the alert, you know. We had to be proactive and not panic so, you know, times if I was probably going to a function in the evening, I’d say to my husband, “Whatever you do make sure you’re vigilant. Keep checking on her. Make sure, you know, if she comes downstairs, just come and check on her. Make sure she’s not taken any knives or anything.” Obviously, you can’t keep hiding knives away but, you know, you have to use them for cooking but I said, “Just be on your guard.” You’re checking up but you’re not making her think that you’re checking on her. You can just pretend that you’re going to make a drink but you’re still being vigilant. So we have to sort of keep communicating, being vigilant, using strategies, you know, and that strategies of safe-keeping and hiding things, you know, just for her own protection.

view profile

Profile Info

Age at interview:

40

Sex:

Female

Background:

Jackie, aged 40, is married with two children. She is a care worker. Ethnic background: White/Scottish.

But here we are, you know. She’s not done it for, I mean for about a year now, in fact before my mum [died]. So it’s over a year since she’s done it. And there’s no lasting marks on her, which is good. But I’m always still on guard even after all this time still looking to see is she doing it? And I’ll always be like that because I just, the thought of her doing it makes me feel sick.

But I still find myself going up to her room, looking round her room for knives. Yesterday I was looking at her, her journal again.

But it, and she does walk about, luckily for me, half naked a lot of the time. So I, I do find myself, not all the time, but I do find myself scanning her. I’m doing a scan but trying not to make it obvious, to see is, is there any fresh wounds, has she done it recently? You know, I’m always checking her, it was always the arms for her. She did do it on the legs a few times, but her choice was always her arms, lower arms, always the lower arms. But I was always checking everywhere else as well.

So I’m al-, I will always always, always be on my guard, always I think, for ever. I think I will always be on my guard. I don’t think it ever leaves you. And it’s a horrible thing to carry around with you. I don’t worry about it all the time because I can’t, I can’t. I never worry about it until it happens. You know, I couldn’t, I’d drive myself demented. I’m not up there every day looking for knives. But certainly I do it, I do, do it, probably more than I’m aware of, checking.

And, and, and then I watch for her mood. She’s in a dark place now obviously with the anniversary [of grandmother's death]. She came in last night, she was really quiet, she went up, I’m like, “Right, okay.” I left her, I didn’t harass her, I gave her, her space, I left her to go up to her room. And I’m not worried that she’s done anything, you know, but I will check her room. You know, there’s always that, it will always, always be there till the day I die I think, that thing that she’ll self-harm.

But I think that I, I would always, I would say to, if, if any parent were to ask me, and I have had a friend say to me, you know, “Do you have any advice?” my advice would be, “Al-, never ever let your guards down, never ever, never be relaxed about it, never.” Because I remember at one point my daughter, she hadn’t, I thought she hadn’t done it for about four months, and I instantly thought, I remember thinking, “Oh, I can relax, that stage of her life’s over. She’s done the drinking, she’s done the underage sex, she’s done the drugs, she’s done the dyeing her hair stupid colours. She’s done the self-harming. That’s it, it’s finished.” I gave my-, I lured myself into a false sense of security, “That’s another phase. That’s that done.” I think I felt maybe even more horrified when I f-, when I found out, “Shit, this isn’t a phase. She’s doing it again” you know.

And that’s the les-, that’s the lesson I learned from that. Always, always be on your guard, but be, have a casual guard up. Make that guard not obvious to them, you know, do it in your own wee world. Always keep, you know, as, as I say, if she leaves her phone around I will look and see what’s going on, because I want to know what’s going on in her life.

Last reviewed December 2017.

We've detected that Javascript is not enabled. It is required for an optimal survey taking experience. Please check your browser's settings and make sure Javascript is turned on. Click here for more information.

Please help us by answering these short questions

There was an error on your page. Please correct any required fields and submit again. Go to the first error

1. Are you:

Parent

Young person

Health professional

Other. Please describe:Please enter an 'other' value for this selection.

2. Where/how did you find out about this site?

Link from another website:Please enter an 'other' value for this selection.

Search engine

Heard about it from a friend

Other. Please state:Please enter an 'other' value for this selection.

Thank you for taking our survey. Your response is very important to us. If you have any further comments, please use the feedback tab on the right of the screen.

Feedback

Please use the form below to tell us what you think of the site. We’d love to hear about how we’ve helped you, how we could improve or if you have found something that’s broken on the site. We are a small team but will try to reply as quickly as possible.

Please note that we are unable to accept article submissions or offer medical advice. If you are affected by any of the issues covered on this website and need to talk to someone in confidence, please contact The Samaritans or your Doctor.